CMS/EIP Fiscal Report Center: 04
Services beginning 04/01/2025 ending 06/30/2025 Date of Report:07/19/2025 Page: 1
List order: No List
Agency Filter:EXT
Eligibility Filter:Part C (excluding not eligible)
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
CASE-CASE-NON-TCM CASE MANAGEMENT 4 1.250000 46.5000 37.2000
TCM-T1017TL-TARGETED CASE MANAGEMENT 90 181.750000 6761.1000 37.2000
Subtotal (Total Children Is Unduplicated) 90 183.000000 6807.6000 37.2000
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Screening, Eval, and Assessment,Class #02
OCTH-97165-OT EVAL LOW COMPLEXITY 16 16.000000 929.7600 58.1100
OCTH-97166-OT EVAL MODERATE COMPLEXITY 2 2.000000 116.2200 58.1100
OCTH-97167-OT EVAL HIGH COMPLEXITY 2 2.000000 116.2200 58.1100
OCTH-97167TLGT-OT EVAL HIGH COMPLEXITY 1 1.000000 58.1100 58.1100
PSTH-97161-PT EVAL LOW COMPLEXITY 13 13.000000 737.9800 56.7677
PSTH-97161GT-PT EVAL LOW COMPLEXITY 2 2.000000 116.2200 58.1100
PSTH-97162-PT EVAL MODERATE COMPLEXITY 2 2.000000 116.2200 58.1100
PSTH-97163GT-PT EVAL HIGH COMPLEXITY 1 1.000000 58.1100 58.1100
SPCH-92521-EVAL OF SPEECH FLUENCY 9 9.000000 522.9900 58.1100
SPCH-92522-EVAL OF SPCH SOUND PROD 4 4.000000 232.4400 58.1100
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 1 1.000000 58.1100 58.1100
Subtotal (Total Children Is Unduplicated) 48 53.000000 3062.3800 57.7808
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 30 55.750000 2787.5000 50.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 2 2.000000 100.0000 50.0000
CONOF-CONOFGT-CONSULT, OT, TELEMEDICINE 2 2.000000 100.0000 50.0000
CONPF-CONPFGT-CONSULT, PT, TELEMEDICINE 2 2.000000 100.0000 50.0000
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 84 1984.500000 53581.5000 27.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 1040 10177.00000 549558.0000 54.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 18 66.250000 3577.5000 54.0000
EPIC-99601-Early Steps Professional Development Fee 878 8864.000000 132960.0000 15.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 220 1649.000000 19788.0000 12.0000
OCCT-97530-OT SESSION BY LICENSED OT 51 203.500000 16548.6200 81.3200
OCCT-97530HM-OT SESSION BY OT ASST 44 226.000000 14741.4200 65.2275
PHY-97110-PT SESSION BY LICENSED PT 59 250.000000 20330.0000 81.3200
PHY-97110HM-PT SESSION BY PT ASST 32 202.500000 13175.6800 65.0651
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 80 318.500000 25900.4200 81.3200
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 11 55.000000 3581.6000 65.1200
Subtotal (Total Children Is Unduplicated) 1201 24058.00000 856830.2400 35.6152
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Total 24294.000000 866700.2200 35.6755
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Number of Children (Unduplicated) With at Least One Service 1228
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Center 04
Flag Claims Units Chgs Paid
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R 15 17.000000 632.4000 0.0000
U 0 0.000000 0.0000 0.0000
B 111 117.000000 4352.4000 0.0000
P 13180 13117.000000 295569.3600 295093.2900
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 8231 8147.000000 445736.2400 219.0000
T 0 0.000000 0.0000 0.0000
1979 2563.000000 94791.7100 90.0000
Other 608 333.000000 25618.1100 -120.0000
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Total 24124 24294.000000 866700.2200 295282.2900